I was on 200 mcg of Synthroid for well over 25 years and continued to have lingering hypo symptoms. All the while I had to fight off the doctors who wanted to lower my dosage, because my TSH was .05. After accidentally finding this Forum 4 years ago, and learning about the importance of Free T3, I got mine tested and confirmed as low. Convinced the doctor to change my meds to Armour Thyroid. After a few bumps in the road when Armour went out of production and then returned to the market, my Free T3 is now 3.9 (range of 2.3 - 4.2) and Free T4 is .84 (range of .60 - 1.50), and I feel best ever.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance. The letter is sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

A good thyroid doctor once told me that dosage was irrelevant, that all that mattered was the clinical response.

Thank you.
I am already on 7.5 of T3 and with out it I think I would be really Hypo!
The last lab was in the middle T3 and very low T4
so we upped the T4 and stayed the same for the T3 dose
I am guessing I may still need to up the T4 and stay or lower T3
Will find out this Thursday.
I was just wondering how high can one go ...
so you were on 200...was that with out T3 medication added??
Mia

I expect that you need to do both. Free T3 is most important because it largely regulates metabolism and many other body functions. Scientific studies have shown that Free T34 correlated best with symptoms, while Free T4 and TSH did not correlate. T4 is important mainly as a prohormone, available to be converted to T4. TSH testing has little value after starting on thyroid meds.

Yes, I was on 200 mcg of T4 only. When I switched meds in order to raise my Free T3 level and relieve symptoms, I started with 2 grains of Armour Thyroid. Now after some tweaking of dosage, I am taking 3 grains of Armour and just added 25 mcg of Synthroid to get my Free T4 up to middle of range.

there is no too high dose, only the dose required to get your levels where they should be.

I currently take 340 mcg of ERFA dessicated thyroid PLUS 100 mcg of T4 (thryoxine). My latest levels are FT4 of 19.21 (range is 12 - 22) and FT3 of 6.33 (2.8 - 7.10). No symptoms of hypo or hyper at this dose and feel good. Fortunately my endo is happy with these results though he does say I am 'not typical' to need such a high dose.

I will give birth shortly and will stop the 100 mcg of T4 immediately after delivery, and then will test the FT3/FT4 6 weeks after giving birth and will then adjust meds further to stay in the upper 1/2 of the reference range.

ok,
Thank you,
I was also wondering if I keep upping the T4 dose would my T3 dose need to drop....so I do not feel hyper?
I guess I will soon find out.
I will keep you posted after seeing the new lab tests. and finding out where the free ranges are....I do have Hasti's... is that why the FreeT4 do not
show any improvement when increasing the dose??
I have gone from T4 95 mcgs to now 125mcgs with the T3 I started out 5 mcg and am now on 7.5 mcg..my Free T3 have been increasing with the last labs to the middle range but the FreeT4 was still very low.
What a science!

Thyroid test results will vary somewhat from time to time without any known change. In general if you increase your T4 med, it will eventually show up as a proportional increase in Free T4. Hashi's would not impact that effect.

Even an increased Free T4 does not have any real impact on symptoms, unless it is adequately converted into T3 and raises your Free T3 level. Free T3 causes the metabolic activity at the cell level.

Your new blood test results will tell us a lot more. BTW Although many doctors like to treat hypo patients like it is a science, it really is an art, which requires a lot more than those doctors are willing to invest in a patient's treatment.

If you are interested in the way it was done before the advent of TSH testing, this is an interesting article. Basically it was clinical treatment.

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